Pre-reform health care

Pre-1990s Soviet Russia had a totally socialist model of health care with a centralised, integrated, hierarchically organised with the government providing free health care to all citizens. All health personnel were state employees. Control of communicable diseases had priority over non-communicable ones. There was over provision of hospital beds, which contributed over time to an imbalance in the overall structure of the health care system. On the whole, the Soviet system tended to neglect primary care, and placed too much emphasis on specialist and hospital care.

Despite weaknesses, the integrated model achieved considerable success in dealing with infectious diseases such as tuberculosis, typhoid fever and typhus. The effectiveness of the model declined with underinvestment. Despite a doubling in the number of hospital beds and doctors per capita between 1950 and 1980, the quality of care began to decline by the early 1980s and medical care and health outcomes were below western standards. The lack of money that had been going into health was patently obvious. Many small district hospitals had no more than 4–5 m2 per bed, and some of the smallest hospitals had no radiology services, and inadequate heating or water. A 1989 survey found that 20% of Russian hospitals did not have piped hot water and 3% did not even have piped cold water. 17% lacked adequate sanitation facilities. Every seventh hospital and polyclinic needed basic reconstruction. Five years after the reforms described below per capital spending on health care was still a meagre US$158 per year (about 8 times less than the average European social models in Spain, the UK and Finland, and 26 times that of the U.S. which spent US$4,187 at that time).^[29]

Reform in 1991-1993

A mobile clinic used to provide health care to people at remote railway stations

The new Russia has changed to a mixed model of health care with private financing and provision running alongside state financing and provision. Article 41 of the 1993 constitution confirmed a citizen's right to healthcare and medical assistance free of charge.^[30] This is achieved through compulsory medical insurance (OMS) rather than just tax funding. This and the introduction of new free market providers was intended to promote both efficiency and patient choice. A purchaser-provider split was also expected to help facilitate the restructuring of care, as resources would migrate to where there was greatest demand, reduce the excess capacity in the hospital sector and stimulate the development of primary care. Finally, it was intended that insurance contributions would supplement budget revenues and thus help to maintain adequate levels of healthcare funding.

The OECD reported ^[31] that unfortunately, none of this has worked out as planned and the reforms have in many respects made the system worse. The population’s health has deteriorated on virtually every measure. Though this is by no means all due to the changes in health care structures, the reforms have proven to be woefully indequate at meeting the needs of the nation. Private health care delivery has not managed to make much inroads and public provision of health care still predominates. The resulting system is overly complex and very inefficient. It has little in common with the model envisaged by the reformers. Although there are more than 300 private insurers and numerous public ones in the market, real competition for patients is rare leaving most patients with little or no effective choice of insurer, and in many places, no choice of health care provider either. The insurance companies have failed to develop as active, informed purchasers of health care services. Most are passive intermediaries, making money by simply channelling funds from regional OMS funds to healthcare providers.

Main source: OECD: Health care reforms in Russia

Reform in 2011

After Putin become a president in 2000 there was significant growth in spending for public healthcare^[5] and in 2006 it exceed the pre-1991 level in real terms.^[5] Also life expectancy increased from 1991-93 levels, infant mortality rate dropped from 18.1 in 1995 to 8.4 in 2008.^[6] Russian Prime Minister Vladimir Putin announced a large large-scale health-care reform in 2011 and pledged to allocate more than 300 billion rubles ($10 billon) in the next few years to improve health care in the country.^[7] He also said that obligatory medical insurance tax paid by companies for compulsory medical insurance will increase from current 3.1% to 5.1% starting from 2011.^[7]

Natality

See also: Demographics of Russia and Aging of Europe

In an effort to stem Russia’s demographic crisis, the government is implementing a number of programs designed to increase the birth rate and attract more migrants to alleviate the problem. The government has doubled monthly child support payments and offered a one-time payment of 250,000 Rubles (around US$10,000) to women who had a second child since 2007.^[32] In 2007, Russia saw the highest birth rate since the collapse of the USSR.^[33] The First Deputy PM also said about 20 billion rubles (about US$1 billion) will be invested in new prenatal centres in Russia in 2008–2009. Immigration is increasingly seen as necessary to sustain the country's population.^[34]

Date: 2015-12-11; view: 905